Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
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Clinical Outcomes of Intracranial Nonvestibular Schwannomas Treated with Linac-Based Stereotactic Radiosurgery and Radiotherapy

  • Puataweepong, Putipun (Radiation and Oncology Unit, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University) ;
  • Dhanachai, Mantana (Radiation and Oncology Unit, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University) ;
  • Hansasuta, Ake (Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University) ;
  • Saetia, Kriangsak (Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University) ;
  • Dangprasert, Somjai (Radiation and Oncology Unit, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University) ;
  • Sitathanee, Chomporn (Radiation and Oncology Unit, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University) ;
  • Yongvithisatid, Pornpan (Radiosurgery Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University)
  • Published : 2016.07.01
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Abstract

Background: Intracranial nonvestibular schwannomas arising from various cranial nerves excluding CN VIII are uncommon. Recently, stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (SRT) have been widely reported as effective treatment modalities for nonvestibular schwannomas. The purpose of this study was to study the long term clinical outcome for nonvestibular schwannomas treated with both X-Knife and CyberKnife (CK) radiosurgery at one institution. Materials and Methods: From 2004 to 2013, fifty-two nonvestibular schwannoma patients were included in this study, 33 patients (63%) were treated with CK, and 19 (37%) were treated with X-Knife. The majority of the tumors were jugular foramen schwannomas (38%) and trigeminal schwannomas (27%). HSRT was given for 45 patients (86%), whereas CSRT was for 6 (12%) and SRS for 1 (2%). Results: The median pretreatment volume was $9.4cm^3$ (range, $0.57-52cm^3$). With the median follow up time of 36 months (range, 3-135), the 3 and 5 year progression free survival was 94 % and 88%, respectively. Tumor size was decreased in 13 (25%), stable in 29 (56%), and increased in 10 (19%). Among the latter, 3 (30%) required additional treatment because of neurologic deterioration. No patient was found to develop any new cranial nerve deficit after SRS/SRT. Conclusions: These data confirmed that SRS/SRT provide high tumor control rates with low complications. Large volume tumors and cystic expansion after radiation should be carefully followed up with neurological examination and MRI, because it may frequently cause neurological deterioration requiring further surgery.

Keywords

References

  1. Al-Mefty O, Ayoubi S, Gaber E (2002). Trigeminal schwannomas: removal of dumbbell-shaped tumors through the expanded Meckel cave and outcomes of cranial nerve function. J Neurosurg, 96, 453-463. https://doi.org/10.3171/jns.2002.96.3.0453
  2. Andrews DW, Suarez O, Goldman HW, et al (2001). Stereotactic radiosurgery and fractionated stereotactic radiotherapy for the treatment of acoustic schwannomas: comparative observations of 125 patients treated at one institution. Int J Radiat Oncol Biol Phys, 50, 1265-1278. https://doi.org/10.1016/S0360-3016(01)01559-0
  3. Bordi L, Compton J, Symon L (1989). Trigeminal neuroma. A report of eleven cases. Surg Neurol, 31, 272-276. https://doi.org/10.1016/0090-3019(89)90051-7
  4. Bulsara KR, Sameshima T, Friedman AH, et al (2008). Microsurgical management of 53 jugular foramen schwannomas: lessons learned incorporated into a modified grading system. J Neurosurg, 109, 794-803. https://doi.org/10.3171/JNS/2008/109/11/0794
  5. Choi CY, Soltys SG, Gibbs IC et al (2011). Stereotactic radiosurgery of cranial nonvestibular schwannomas: results of single- and multisession radiosurgery. Neurosurgery, 68, 1200-8. https://doi.org/10.1227/NEU.0b013e31820c0474
  6. Chung HT, Ma R, Toyota B et al (2004). Audiologic and treatment outcomes after linear accelerator-based stereotactic irradiation for acoustic neuroma. Int J Radiat Oncol Biol Phys, 59, 1116-21. https://doi.org/10.1016/j.ijrobp.2003.12.032
  7. Collen C, Ampe B, Gevaert T, et al (2011). Single fraction versus fractionated linac-based stereotactic radiotherapy for vestibular schwannoma: a single-institution experience. Int J Radiat Oncol Biol Phys, 81, 503-9.
  8. Elsharkawy M, Xu Z, Schlesinger D, et al (2012). Gamma Knife surgery for nonvestibular schwannomas: radiological and clinical outcomes. J Neurosurg, 116, 66-72. https://doi.org/10.3171/2011.8.JNS11215
  9. Fong BM, Pezeshkian P, Nagasawa DT, et al (2012). Hearing preservation after LINAC radiosurgery and LINAC radiotherapy for vestibular schwannoma. J Clin Neurosci, 19, 1065-70. https://doi.org/10.1016/j.jocn.2012.01.015
  10. Goel A, Muzumdar D, Raman C (2003). Trigeminal neuroma: analysis of surgical experience with 73 cases. Neurosurgery, 52, 783-90. https://doi.org/10.1227/01.NEU.0000053365.05795.03
  11. Hamm KD, Gross MW, Fahrig A, et al (2008). Stereotactic radiotherapy for the treatment of nonacoustic schwannomas. Neurosurgery, 62, 29-36. https://doi.org/10.1227/01.neu.0000325934.16229.03
  12. Hasegawa T, Kida Y, Yoshimoto M, et al (2006). Evaluation of tumor expansion after stereotactic radiosurgery in patients harboring vestibular schwannomas. Neurosurgery, 58, 1119-28. https://doi.org/10.1227/01.NEU.0000215947.35646.DD
  13. Kadri PA, Al-Mefty O (2004). Surgical treatment of dumbbellshaped jugular foramen schwannomas. Neurosurg Focus, 17, 9. https://doi.org/10.3171/foc.2004.17.1.2
  14. Kimball MM, Foote KD, Bova FJ, et al (2011). Linear accelerator radiosurgery for nonvestibular schwannomas. Neurosurgery, 68, 974-84. https://doi.org/10.1227/NEU.0b013e318208f3a1
  15. Koos WT, Day JD, Matula C (1998). Neurotopographic considerations in the microsurgical treatment of small acoustic neurinomas. J Neurosurg, 88, 506-12. https://doi.org/10.3171/jns.1998.88.3.0506
  16. Lee SK, Park K, Kong DS, et al (2001). Surgical tactics and outcome of treatment in jugular foramen schwannomas. J Clin Neurosci, 8, 32-9. https://doi.org/10.1054/jocn.2001.0874
  17. Mabanta SR, Buatti JM, Friedman WA, et al (1999). Linear accelerator radiosurgery for nonacoustic schwannomas. Int J Radiat Oncol Biol Phys, 43, 545-8. https://doi.org/10.1016/S0360-3016(98)00445-3
  18. MacNally SP, Rutherford SA, Ramsden RT, et al (2008). Trigeminal schwannomas. Br J Neurosurg, 22, 729-38. https://doi.org/10.1080/02688690802272172
  19. Nagano O, Higuchi Y, Serizawa T et al (2008). Transient expansion of vestibular schwannoma following stereotactic radiosurgery. J Neurosurg, 109, 811-6. https://doi.org/10.3171/JNS/2008/109/11/0811
  20. Nishioka K, Abo D, Aoyama H, et al (2009). Stereotactic radiotherapy for intracranial nonacoustic schwannomas including facial nerve schwannoma. Int J Radiat Oncol Biol Phys, 75, 1415-9. https://doi.org/10.1016/j.ijrobp.2008.12.063
  21. Ostrom QT, Gittleman H, Fulop J, et al (2015). CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2008-2012. Neuro Oncol, 17, 1-62. https://doi.org/10.1093/neuonc/nou334
  22. Pollack IF, Sekhar LN, Jannetta PJ, et al (1989). Neurilemomas of the trigeminal nerve. J Neurosurg, 70, 737-45. https://doi.org/10.3171/jns.1989.70.5.0737
  23. Pollock BE (2006). Management of vestibular schwannomas that enlarge after stereotactic radiosurgery: treatment recommendations based on a 15 year experience. Neurosurgery, 58, 241-8. https://doi.org/10.1227/01.NEU.0000194833.66593.8B
  24. Pollock BE, Foote RL, Stafford SL (2002). Stereotactic radiosurgery: the preferred management for patients with nonvestibular schwannomas? Int J Radiat Oncol Biol Phys, 52, 1002-7. https://doi.org/10.1016/S0360-3016(01)02711-0
  25. Puataweepong P, Dhanachai M, Dangprasert S, et al (2014). Linac-based stereotactic radiosurgery and fractionated stereotactic radiotherapy for vestibular schwannomas: comparative observations of 139 patients treated at a single institution. J Radiat Res, 55, 351-8. https://doi.org/10.1093/jrr/rrt121
  26. Puataweepong P, Dhanachai M, Hansasuta A et al (2014). The clinical outcome of intracranial hemangioblastomas treated with linac-based stereotactic radiosurgery and radiotherapy. J Radiat Res, 55, 761-8. https://doi.org/10.1093/jrr/rrt235
  27. Puataweepong P, Dhanachai M, Hansasuta A, et al (2015). Outcomes for pituitary adenoma patients treated with linacbased stereotactic radiosurgery and radiotherapy: a long term experience in Thailand. Asian Pac J Cancer Prev, 16, 5279-84. https://doi.org/10.7314/APJCP.2015.16.13.5279
  28. Safavi-Abbasi S, Bambakidis NC, Zabramski JM et al (2010). Nonvestibular schwannomas: an evaluation of functional outcome after radiosurgical and microsurgical management. Acta Neurochir 152, 35-46. https://doi.org/10.1007/s00701-009-0403-5
  29. Samii M, Babu RP, Tatagiba M, et al (1995). Surgical treatment of jugular foramen schwannomas. J Neurosurg, 82, 924-32. https://doi.org/10.3171/jns.1995.82.6.0924
  30. Sanna M, Bacciu A, Falcioni M, et al (2006). Surgical management of jugular foramen schwannomas with hearing and facial nerve function preservation: a series of 23 cases and review of the literature. Laryngoscope, 116, 2191-204. https://doi.org/10.1097/01.mlg.0000246193.84319.e5
  31. Sarma S, Sekhar LN, Schessel DA (2002). Nonvestibular schwannomas of the brain: a 7-year experience. Neurosurgery, 50, 437-48.
  32. Sharma BS, Ahmad FU, Chandra PS, et al (2008). Trigeminal schwannomas: experience with 68 cases. J Clin Neurosci, 15, 738-743. https://doi.org/10.1016/j.jocn.2006.09.007
  33. Showalter TN, Werner-Wasik M, Curran WJ, et al (2008). Stereotactic radiosurgery and fractionated stereotactic radiotherapy for the treatment of nonacoustic cranial nerve schwannomas. Neurosurgery, 63, 734-740. https://doi.org/10.1227/01.NEU.0000325496.10148.B3
  34. Snell JW, Sheehan J, Stroila M et al (2006). Assessment of imaging studies used with radiosurgery: a volumetric algorithm and an estimation of its error. Technical note. J Neurosurg, 104, 157-62. https://doi.org/10.3171/jns.2006.104.1.157
  35. Zabel A, Debus J, Thilmann C et al (2001). Management of benign cranial nonacoustic schwannomas by fractionated stereotactic radiotherapy. Int J Cancer, 96, 356-62. https://doi.org/10.1002/ijc.1036
  36. Zhang L, Yang Y, Xu S et al (2009). Trigeminal schwannomas: a report of 42 cases and review of the relevant surgical approaches. Clin Neurol Neurosurg, 111, 261-9. https://doi.org/10.1016/j.clineuro.2008.10.014